CH 19: Conditions Existing Before Conception

Tay-Sachs disease

A human genetic disease caused by a recessive allele that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth. Most often occurring in patients with Jewish ancestry.

A nurse should instruct a client who has a very low sperm count to make which lifestyle modification? A) Have intercourse every other day. B)Have intercourse only once a month. C) Abstain from intercourse for 8 days at a time. D) Abstain from intercourse for 15 days at a time.

C) Abstain from intercourse for 8 days at a time. The nurse should advise the client to abstain from intercourse for 7 to 10 days at a time to increase sperm counts.

Iron is best absorbed from

an acid medium such as orange juice

macrosomia

large-bodied baby commonly seen in diabetic pregnancies

Biophysical Profile (BPP)

uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus.

When evaluating fetal well-being, what is the maximum score on a biophysical profile?

10

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? A) Both parents have to carry the trait. B) There is a good chance the infant will inherit the disease from the mother. C) The infant inherits the disease from the father. D) If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia.

A) Both parents have to carry the trait Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. The infant will not develop the disease just because the mother has a crisis during the pregnancy.

A nurse is reading a journal article about genetic inheritance. Information on which condition would the nurse most likely read about in the section on autosomal recessive disorders? Select all that apply. A) Cystic fibrosis B) phenylketonuria C) Tay-Sachs disease D) polycystic kidney disease D) achondroplasia

A) Cystic fibrosis B) phenylketonuria C) Tay-Sachs disease

A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? A) 45 mg/dL B) 85 mg/dL C) 120 mg/dL D) 136 mg/dL

B) 85 mg/dL Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dL. A fasting blood glucose level of 45 g/dL is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dL is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dL in a pregnant client indicates hyperglycemia.

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? A) monthly visits until 32 weeks, then bi-monthly visits B) bi-monthly visits until 28 weeks, then weekly visits C) monthly visits until 20 weeks, then bi-monthly visits D) bi-monthly visits until 36 weeks, then weekly visits

B) bi-monthly visits until 28 weeks, then weekly visits For the woman with chronic hypertension, antepartum visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance.

A nurse is client teaching with a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? A) avoidance of infection B) constipation prevention C) administration of immunoglobulins D) consumption of a low-fat diet

A) avoidance of infection Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.

A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition? A) Hydroxyurea B) Corticosteroids C) Beta2 agonists D) Prostaglandin E

B) Coritcosteroid Corticosteroid therapy is the treatment of choice for pregnant clients with SLE. SLE is an autoimmune disorder where there is deposition of immune complexes in the capillaries and in visceral structure. Corticosteroid therapy in pregnant clients with SLE has a favorable outcome. Hydroxyurea, beta2 agonists and prostaglandin E are not used in the treatment of pregnant clients with SLE. Hydroxyurea is a drug used in the treatment of sickle cell anemia. Beta2 agonists are drugs given to asthmatic clients. Prostaglandin E is a drug used for the induction of labor.

A pregnant woman with a history of mitral stenosis is to be prescribed medication as treatment. Which of the following medication classes would the nurse expect the patient to begin taking? A) anticoagulant B) diuretic C) antihypertensive D) antineoplastic

A) Anticoagulant In mitral stenosis, it is difficult for blood to leave the left atrium. A secondary problem of thrombus formation may develop as a result of noncirculating blood. A woman may need to be prescribed an anticoagulant to prevent this.

A nursing student is preparing an oral presentation about autosomal recessive inheritance. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.

A) Both parents must be heterozygous carriers. Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal, but carriers of the gene).

three primary tests used to assess fertility

semen analysis, ovulation monitoring, and tubal patency assessment

How long does a patient with Lupus need to be in stable or in remission before trying to conceive?

6 months

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate? A) Hyperglycemia B) macrosomia C) hypoglycemia D) birth trauma

A) Hyperglycemia Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

The nursing instructor is pointing out the various complcations which can occur during pregnancy in women with diabetes mellitus. The instructor determines the session is successful after the students correctly choose which complication that can occur if the diabetes is not kept under control? A) hydramnios B) placenta previa C) cerebral vascular accident D) hypotension

A) hydramnios Out-of-control diabetes can result in hyperglycemia which tends to lead to excessive amniotic fluid (hydramnios or polyhydramnios) because of osmotic pressure fluid shifts. A small placenta is more common than placenta previa. The woman may experience hypertension versus hypotension if the diabetes is not controlled. Cerebral vascular accidents are usually not related to diabetes but to circulatory issues.

Which change best describes the insulin needs of a client with type 1 diabetes mellitus who has just delivered an infant vaginally without complications? A) Increased B) Decreased C) The same as before pregnancy D) The same as during pregnancy

B) Decreased The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease, and women with type 1 diabetes may need only one-half to two-thirds of the prenatal insulin dose during the first few postpartum days. Blood glucose levels should be monitored and insulin dosages adjusted as needed. The client should be encouraged to maintain appropriate dietary schedules, even if her infant is feeding on demand.

A nurse is conducting a class for a group of couples about subfertility. When describing the causes of subfertility, which cause would the nurse include as being most common? A) pelvic inflammatory disease B) anovulation C) excessive exercise D) excess body weight

B) anovulation Anovulation is the most common cause of infertility. It means the absence of ovulation.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? A) antihypertensive drugs B) diuretic drugs C) I.V. fluids D) antibiotics

C) I.V. fluids A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client would be given antibiotics only if there were evidence of an infection.

Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? A) "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly." B) "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra every day." C) "You have a nice slender body type. Just eat what you want and you will do fine." D) "You should be eating an extra 200 kcal over what you were eating while you were pregnant."

D) "You should be eating an extra 200 kcal over what you were eating while you were pregnant." Instruct the woman who is not breastfeeding to decrease her caloric intake by approximately 300 kcal per day (i.e., she should reduce her intake to prepregnancy levels). The lactating woman will need to add an additional 200 kcal above the pregnancy requirement of 300 kcal per day, for a total of 500 kcal above prepregnancy requirements.

A 17-year-old primigravida with type 1 diabetes is at 37 weeks gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? A) Scheduling the woman for induction of labor today. B) Allowing her to continue without plans for delivery. C) Scheduling a cesarean delivery at 39 weeks. D) Preparing for amniocentesis and fetal lung maturity assessment

D) Preparing for amniocentesis and fetal lung maturity assessment If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

A woman with no previous history of heart disease begins to have symptoms of myocardial failure a few weeks before the birth of her first child. Findings include shortness of breath, chest pain, and edema, with her heart also showing enlargement. The nurse suspects which condition? A) mitral stenosis B) left-sided heart failure C) pulmonary valve stenosis D) peripartal cardiomyopathy

D) peripartal cardiomyopathy Peripartal cardiomyopathy can occur in pregnancy without any previous history of heart disease. Symptoms include shortness of breath, chest pain, and edema; also, the heart begins to increase. Treatment is with a diuretic, an antidysrhythmic agent, digitalis, low weight heparin, and bed rest.

A client in her eighth month of pregnancy who has cardiac disease is experiencing profound shortness of breath and a cough that produces blood-speckled sputum, in addition to systemic hypotension. The nurse recognizes that this patient most likely is experiencing which condition? A) Left-sided heart failure B) Right-sided heart failure C) Peripartal cardiomyopathy D) Pulmonary embolism

A) Left-sided heart failure In left-sided heart failure, the left ventricle cannot move the large volume of blood forward that it has received by the left atrium from the pulmonary circulation. It is characterized by a decrease in systemic blood pressure and pulmonary edema that produces profound shortness of breath. If pulmonary capillaries rupture under the pressure, small amounts of blood leak into the alveoli and the woman develops a productive cough with blood-speckled sputum. Right-sided heart failure is characterized by extreme liver enlargement, distention of abdominal and lower extremity vessels, ascites, and peripheral edema. A woman with peripartal cardiomyopathy develops signs of myocardial failure such as shortness of breath, chest pain, and nondependent edema. Her heart increases in size (cardiomegaly).The signs of a pulmonary embolism include chest pain, a sudden onset of dyspnea, a cough with hemoptysis, tachycardia or missed beats, or dizziness and fainting.

A pregnant client has a history of asthma. After reveiwing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used? A) Misoprotosol B) budesonide C) albuterol D) salmeterol

A) Misoprotosol Three specific drugs recommended for use for controlling asthma during pregnancy are budesonide, albuterol, and salmeterol. Misoprostol is a prostaglandin that is used for treating postpartum hemorrhage but is contraindicated with asthma clients due to the risk of bronchial spasm and bronchoconstriction.

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? A) respiratory function B) heart rate C) temperature D) urine output

A) Respiratory function The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority.

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? A) swelling of the face B) dry, rasping cough C) slow, labored respiration D) elevated temperature

A) Swelling of the face Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A) Hemoglobin of 13 or lower B) Hematocrit of 32% or less C) Blood pressure of 100/68 D) Heart rate of 84

B) Hematocrit of 32% or less Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. A) Decreased birth weight B) Increased risk of spontaneous abortion C) Polyhydramnios D) Hypertension E) Cystic fibrosis

B) Increased risk of spontaneous abortion C) Polyhydramnios D) Hypertension

The nurse is presenting a class at a local community health center on violence during pregnancy. Which possible complication would the nurse include? A) gestational hypertension B) chorioamnionitis C) Placenta previa D) postterm labor

B) chorioamnionitis Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Gestational hypertension is not associated with violence during pregnancy.

A pregnant patient asks why an α-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test? A) It screens for placenta function. B) It measures the fetal liver function. C) It may reveal chromosomal abnormalities. D) It tests the ability of the patient's heart to accommodate the pregnancy

C) It may reveal chromosomal abnormalities α-Fetoprotein (AFP) is a substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum. The level is abnormally high if the fetus has an open spinal or abdominal wall defect because the open defect allows more AFP to enter the mother's circulation. Although the reason is unclear, the level is low if the fetus has a chromosomal defect such as Down syndrome. Between 85% and 90% of neural tube anomalies, and 80% of Down syndrome babies can be detected by this method. The α-fetoprotein level is not used to screen for placenta functioning, measure fetal liver function, or test the ability of the patient's heart to accommodate the pregnancy.

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which conditon? A) β-thalassemia B) α-thalassemia C) sickle cell anemia D) Tay-Sachs disease

A) β-thalassemia Different ancestry backgrounds cause different genetic disorders to be more common in some ethnic groups than in others. The blood disorder β-thalassemia, for example, occurs most frequently in families of Greek or Mediterranean heritage, whereas α-thalassemia occurs most often in persons from the Philippines or southeast Asia. Sickle-cell anemia occurs most often in people with an African ancestry. Tay-Sachs disease, a deterioration of muscle and mental facilities, occurs most often in people of eastern Jewish ancestry.

A nursing instructor is teaching students about caring for a pregnant patient with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? A) Women seeking out earlier prenatal care B) More women waiting until after age 30 years to get pregnant C) Better tests to diagnose diseases D) Better assessment skills by physicians

B) More women waiting until after age 30 years to get pregnant As more women wait until they are older than 30 years to have their first child, more also enter pregnancy with a pre-existing disorder.

The nurse is caring for a pregnant client who has a class II heart disease. The nurse is prepared to intensify monitoring during which period of the pregnancy? A) First trimester B) Second trimester C) Third trimester D) All are at equal risk

B) Second trimester The periods of greatest risk for the pregnant woman with a cardiac disease are at the end of the second trimester (when blood volume peaks), during labor, and in the early postpartum period secondary to fluid shifts.

A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? A) heart disease B) anemia C) rickets D) scurvy

B) anemia The nurse should make the client aware of increased risk of anemia as a possible effect of maternal coffee consumption during pregnancy, as it decreases iron absorption. Maternal coffee consumption during pregnancy does not increase the risk of heart disease, rickets, or scurvy.

A patient with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this patient's concern? A) Asthma medication is teratogenic and should not be taken. B) Asthma improves during pregnancy so higher doses are not needed. C) Asthma medication may reduce labor contractions and should be reduced. D) Asthma medication is ineffective during pregnancy and should be stopped.

C) Asthma medication may reduce labor contractions and should be reduced. Some asthma maintenance medication such as beta-adrenergic agonists may be taken safely during pregnancy, but they have the potential to reduce labor contractions. The doses of these medications may be reduced as the patient approaches the time of delivery. Not all asthma medication is teratogenic. Asthma can improve during pregnancy because of circulating corticosteroids; however, the doses of the medications should have already been adjusted according to the patient's symptoms. There is no evidence to support that asthma medication is ineffective during pregnancy.

Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? A) Diabetic clients who breast-feed have a hard time controlling their insulin needs B) Diabetic clients shouldn't breast-feed because of potential complications C) Diabetic clients shouldn't breast-feed; insulin requirements are doubled D) Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

D) Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding Breast-feeding has an antidiabetic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding clients are at a higher risk for hypoglycemia in the first postpartum days after birth because glucose levels are lower. Diabetic clients should be encouraged to breast-feed.

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? A) Dried apples B) Fortified grains C) Dried beans D) Orange juice

D) Orange juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.